Tobacco use harm reduction, elimination, and escalation in a large military cohort.

Abstract:

OBJECTIVES:We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). METHODS:Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. RESULTS:Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. CONCLUSIONS:When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.

journal_name

Am J Public Health

authors

Klesges RC,Sherrill-Mittleman D,Ebbert JO,Talcott GW,Debon M

doi

10.2105/AJPH.2009.175091

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

2487-92

issue

12

eissn

0090-0036

issn

1541-0048

pii

100/12/2487

journal_volume

100

pub_type

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